Navigating Patient Assistance Programs

With the uncertainty of healthcare, many in the bleeding disorders community are concerned about the future of cost and access to factor products. Co-payments and out-of-pocket expenses can be devastating on a family’s budget. Assistance programs can provide a source of relief.

Note: The programs and services listed below are independent of HFA and provided as a courtesy to our community families. Programs change frequently and we do our best to keep this resource up-to-date. Please contact these organizations directly to inquire about their support.

• Your enrollment in the program is valid for up to 12 months (You may reapply at the end of 12 months).

• The program covers the remaining part of your co-pay, up to $15,000 per year.

You may be eligible if you:

• Have been prescribed HEMLIBRA for an FDA-approved indication.

• Are 18 years of age or older, or have a legal guardian 18 years of age or older to manage the program.

• Have commercial (private or nongovernmental) insurance. This includes plans available through state and federal health insurance marketplaces.

• Do not receive support from the Genentech® Access to Care Foundation (GATCF) or any other independent co pay assistance foundations for HEMLIBRA.

• Are not a government beneficiary and/or participant in a federal or state-funded health insurance program (eg, Medicare, Medicare Advantage, Medigap, Medicaid, VA, DoD or TRICARE).

• Do not reside in a state where the program is prohibited.

Grifols

Factors for Health Patient Support Program

1-844-693-2286

(844-MY-FACTOR)

No limit for in-network

Out of network: Will cover $2,000 of the claim

• Pay as little as $0 for ALPHANATE and Alphanine SD.

• No monthly or annual maximums. Individual

claims exceeding $2000 will be reviewed for network eligibility. Claims that are in-network will be approved, but those out-of-network may be denied.

• Prescription is covered up to the patient’s annual out of pocket (OOP)maximum. The general OOP maximum limits under the affordable care act are $6850 (self-only coverage) and $13,700 (coverage for more than self only).

• No waiting period; patients may use the offer as soon as they enroll.

• No income requirements.

• Annual program enrollment is required.

• Must have commercial insurance.

• Patients must have a valid ALPHANATE or AlphaNine SD prescription.

• Restrictions apply.

Helps to cover co-pay and co-insurance costs for ALPHANATE and AlphaNine SD only. It does not cover costs related to physician visits and is not for inpatient use.

• Have hemophilia A and have been prescribed an appropriate Novo Nordisk factor treatment; OR

• Have congenital hemophilia A or B with an inhibitor, congenital FVII deficiency, Glanzmann’s thrombasthenia with refractoriness to platelet transfusions, or acquired hemophilia and have been prescribed an appropriate Novo Nordisk factor treatment; OR

• Have FXIII A-subunit deficiency and have been prescribed an appropriate Novo Nordisk factor treatment; AND

• Eligible patients with private insurance receive up to $12,000 every 12

months for medication-related co-payment/co-insurance with retroactive

assistance for a date of service within 120 days prior to their co-pay

activation date.

• No income requirements.

• Adynovate follows FDA guidelines (approved for 12 years of age or older).

• Program is only valid for residents of the United States, excluding Puerto Rico and other U.S. territories.

*HFA makes every attempt to provide accurate information regarding patient assistance programs and resources. However, since program policies often change, please contact the manufacturer directly for the most updated information. This chart hasbeen updated on March 7, 2018.

For those in the bleeding disorder community who are uninsured, underinsured, or experiencing lapses in insurance coverage, there are also assistance programs to help families facing financial strain get access to factor products.

Manufacturer Product Assistance Programs

Company/Organization

Product Assistance Program Name & Contact Information

Akorn Pharmaceuticals

Patient Assistance Program: This needs-based program assists patients in accessing Amicar. Programs include copay assistance for patients with commercial insurance coverage and a need based support program for those patients without commercial insurance. These are newly created programs to support your access to the product and reduce copay obligation automatically at participating pharmacies. Click on the link above to locate programs.:. 1-844-202-5909

Aptevo Therapeutics

IXINITY Patient Assistance Program: For patients who are uninsured or experiencing a lapse in coverage to access treatment. Must meet income requirements. 1-855-494-6489

Bayer

GAP Coverage Program: Patients who are unemployed or have a loss or lapse in private insurance coverage; connects you to temporary insurance coverage.

Patient Assistance Program: Patients who do not have insurance, lack third-party coverage, or have pending Medicaid approval may be eligible to receive Kogenate FS. 1-800-288-8374

Bioverativ

Factor Access Program: Patients using ALPROLIX or ELOCTATE who have no prescription coverage, are facing a gap in coverage, or have reached their maximum insurance coverage limit, may be eligible to receive product for free. Other restrictions may apply.

For ALPROLIX 1-855-692-5776

For ELOCTATE 1-855-693-5628

CSL Behring

Patient Assistance Program: To be eligible, patients must be underinsured or uninsured. When enrolled, must actively be seeking insurance.

Assurance Program: Must currently have private health insurance coverage; this is a certificate program that helps with potential future lapses in private health insurance plans. 1-800-676-4266

Genentech

GATCF helps people who don’t have health insurance. It also helps people who have health insurance but have trouble paying for HEMLIBRA. If you qualify for GATCF, you could receive your medicine for free. For more information, call 877-233-3981 or visit hemlibra.com/access.

Grifols

Grifols Patient Assistance Program: This program is for patients using ALPHANATE, AlphaNine SD or ProfilNINE who are uninsured or experiencing a temporary lapse of insurance coverage. 1-844-MYFACTOR (1-844-693-2286)

Kedrion Biopharma

1-855-353-7466

Novo Nordisk

Novo Nordisk Product Assistance Program: Provides medication to qualifying applicants at no charge. Eligible patients must have been prescribed a Novo Nordisk product for an indicated condition (check the website for a complete list of eligible conditions), have no insurance coverage, and actively be seeking insurance coverage. Patient must be a documented US resident or on a path to documented status with reasonable likelihood of attaining it. Federal government insurance programs are ineligible. 1-844-668-6732

Octapharma

NUWIQ Free Trial Program allows for up to six (6) doses, or 20,000 IUs, of NUWIQ. A prescription for NUWIQ is required and other restrictions may apply.

Wilate Free Trial Program allows for up to 5,000 IUs for Wilate. A prescription for Wilate is required and other restrictions may apply.

1-800-554-4440

Pfizer

Pfizer Patient Assistance Program: Patients must meet income guidelines, which vary by product and household size; have no prescription coverage, or not enough coverage, to pay for their medicine; live in the United States or US territories; and be treated by a health care professional licensed in US/PR 1-844-989-PATH (7284)

For use of Daklinza up to a maximum benefit of $5,000 per 28-day supply of 30mg or 60mg OR up to a maximum benefit of $10,000 per 28-day supply of 90mg

· You are insured by commercial insurance and your insurance coverage does not cover the full cost of your prescription; that is, you have a co-pay obliga- tion.

· You do not have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs. Patients who move from commercial to a state or federal healthcare program will no longer be eligible.

The HARVONI Co- pay Coupon Pro- gram will cover the out-of-pocket costs of your HARVONI pre- scriptions after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price of a 12-week regimen of HARVONI. The offer is valid for six (6) months from the time of first redemption.

· Eligible residents of the US, Puerto Rico, or US territories at participating eligible retail, specialty, or mail-order pharmacies in the US, Puerto Rico, or US territories.

· Coupon not valid for prescriptions eligible for reimbursement in whole or part by federal or state health care programs (e.g., Medicaid/Medicare) or for com- mercial health coverage that will cover entire cost of prescription.

· Patients must have valid medical insurance coverage. Please note, patients who are applying for co-payment assistance must have at least 50% insurance cover- age or more to be eligible for co-payment assistance, excluding deductibles.

· Patients must have been prescribed a medication that is part of the Good Days formulary.

· Patients must meet our annual household income criteria.

· (Note: Program may open and close throughout the year depending on funding.)

NovoSecure enrollees can apply for a variety of programs, including competitive scholarships, life coaching with HeroPath, career counseling, and insurance support. Eligibility for programs vary. Must have hemophilia A, hemophilia A or B with inhibitors, factor VII deficiency, factor XIII deficiency, acquired hemophilia, or Glanzmann’s Thrombasthenia to apply. Novo Nordisk product usage is not an eligibility requirement.

Patients with commercial insurance (i.e. – Individual, Group, Marketplace/Exchange, COBRA) are eligible to receive financial support regardless of product, with a “first come; first serve” policy, if the commercial program is adequately funded and they are deemed eligible for assistance. If approved for assistance, patients can receive up to $11,000.00 per year in premium support.

Assistance Programs for Public Insured Patients

Patients with public insurance (i.e. – All forms of Medicare, Medicaid, Supplemental, Medigap, etc.) are eligible to receive financial support regardless of product, with a “first come; first serve” policy, if the public program is adequately funded and they are deemed eligible for assistance. If approved for assistance, patients can receive up to $11,000.00 per year in premium support.

Provides medical grants to help children gain access to health-related services not covered, or not fully covered, by a commercial health insurance plan. Do not need to have United Healthcare to be eligible.

Provides free and confidential information and referrals to local services including housing, food, employment, healthcare, counseling, and more. Check the website or call your local United Way tosee if your state offers this service.